Louis Wirth, sociologist, as cited in Wikepedia, the free encyclopedia defined that “a minority group as “a group of people who, because of their physical or cultural characteristics, are singled out from the others in the society in which they live for differential and unequal treatment and who therefore regard themselves as objects of collective discrimination. Types of minority groups consist of some categories for instance racial or ethnic minorities, religious minorities, gender and sexual minorities, age minorities, disabled minorities, minority of political party, and minority of language and nationality. Because the minority scope is very broad, for this paper I will only focus on minority groups relating to sexual minorities. These target groups are very important to be discussed because they often get inequality and discrimination that will affect the health status of sexual minorities groups. Minority groups that I mean in this paper are Gay, Lesbian, Bisexual and Transgender (GLBT).
It is estimated around 8 – 10 million people of 241,973,872 of Indonesian population are homosexual, they have the same sexual orientation: men-men or women-women (Budijanto, 2001). Men who have sex with men are called as gay; conversely women who have sex with women are called as lesbian. Some of them have bisexual orientation, can be men-men and men-women or women-women and women-men. Furthermore, it is difference from transgender. Transgender refers to a male dressed as a female.
2. Health Status of Minority Groups
Gay, Lesbian, Bisexual and Transgender (GLBT) groups are groups that are often marginalized from society. This happens because widely community has not received yet their identity; so that is way they are not getting the same rights with other people. As a consequence of that, some facts show suicide rates are increasing among them and this is minority groups’ health problems experienced them. Even though suicides rates or mental disorder particularly depression are not a single factor but 90% of suicide rates are caused by individual and family condition, loss of a loved one and so on (WHO, 2008). In 2000, in the worldwide it is estimated one death in every 40 seconds. Today, suicides rates are to be the three major causes of death among the 15-44 ages group both males and females. These cases are only for completed suicides, it does not include suicide attempts. Traditionally death rate for male elderly groups is the highest rates among the other age groups. The number of suicide rate for young people also increase in both developed countries and developing countries. These cases are the highest risk in a third of those countries (WHO, 2008).
A result of research presented on 130th annual meeting “American Public Health Association” in 2003 in Philadelphia showed lesbian is more susceptible and easier to get social and health problems such as drug use, suicide, smoking, tattoo than gay because 1). Lesbian’s sexual orientation generally occurs at older age than gay, 2). Lesbian does not like to use condom or others to do safe sex, 3). Generally lesbian is bisexual so lesbian does not only love or like to women but also to men (Science and Homosexual, 2003).
Data relating for minority groups especially GLBT in Indonesia are very limited so it is difficult for health care professionals and public health leaders to explain this cases further. Indonesia government does not provide specific programs and budgeting for GLBT groups so it is not easy to measure government involvement in relating to minority groups’ health problems. Generally, health problems experienced by GLBT groups such as Tuberculosis, Hepatitis B and Hepatitis C, suicide and self harm, morbidity rate and so on are not reported except sexually transmitted infections particularly HIV/AIDS cases or IDUs. Therefore, in this paper I just want to describe some facts that happen at GLBT as a minority group.
A survey was conducted by Lubis, et al. (2006) in Jakarta states that most transvestites fear HIV/AIDS. They do not have sufficient information to determine whether they are infected or not but they are willing to change their sexual behavior. From over 600 transvestites 40 percent have 8 or more different sex partners per week. This survey also found that low risk receptive are oral sex, thigh massage (simulated vaginal sex) and masturbation of the client were routine activities but high risk receptive anal sex without condoms was most common.
In South Sulawesi, a Non Government Organisation “ Gaya Celebes Foundation” which promotes HIV/AIDS program on GLBT groups reported that the number of GLBTs is around 7,000-8,000 people. The actual number is to be much more than reported data because many people do not want to give their identity openly. It is predicted 300 people infected with HIV/AIDS among Gaya Celebes Foundation’s target groups.
3. The social determinant and policies that affect the health of minorities groups
There are many factors influencing a person’ health status. They are norms, social relationship, social networks, discrimination, social hierarchy for instance per capita income distribution, public policies such as housing and education (Galea and Vlahov, 2002). These factors refer to social determinants. The role of social determinants is connected with the health of minority groups. Some factors affecting this minority group’s health problems will be explained below:
According to psychobiological stress model proposed by Frankenhaeusers et al. (1989) citied in Eisler & Hersen, (1999, p. 26) “stress is caused by an imbalance between perceived demands and perceived resources. It means stress can occur caused by work overload and too much responsibility, lack of meaningful activities, monotonous, repetitive tasks, lack of development to meet these demands. Another model is the Job Strain Model proposed by Karasek and Theorell (Karasek, 1979; Karasek & Theorell, 1990, cited in Eisler & Hersen, 1999, p. 27). This model proposes that stress occur the combination of work overload and morbidity and poor health. Low social support has been added to this model as a risk factor.
Therefore, stress is very harmful for all people especially minority groups because it is imbalance between happen and expected needs. They have psychological problems because generally community have not acknowledged and received yet their identity. Stress often occurs at people who have bisexual orientation. Men have sex with men and men have sex with women conversely women have sex with women and men (Science and Homosexual, 2003).
3.2 Social exclusion
Social exclusion, marginalisation, and discrimination can all harm health. Social exclusion is associated with unemployment and poverty, and the risk factors to health of being low on the social ladder.
Social exclusion relates to discrimination based on difference. Some years ago, for example, indigenous Australians have experienced discrimination and alienation from their government and society. In fact, Aborigines and Torres Strait Islanders have bad health status compared with non-indigenous people. Some Aborigines still suffer from leprosy, rheumatic heart disease, tuberculosis and other non communicable disease. Aborigines have an average life expectancy 17 years below than white Australians. This condition is caused by stress, alienation, discrimination and lack of control (Couzos and Murray, 2008, p. 791).
People experiencing social exclusion have low levels of personal control, loneliness and unhappiness. Mental health services’ needs increase for people experiencing discrimination (Turrell et al. 1999, cited in Keleher & Murphy, 2004, p. 248).
In relation to GLBT as minority groups, generally, Indonesian community have not received yet about existence of them particularly in villages although some of them have to brave to coming out. Discrimination still often occurs to them, for instance: 1). A mother bans her boy to be friend with transgender, 2). Transgender did not get treatment well from a doctor or health providers, 3). Transgender were caught by a police and threw them to sea and after that, the police brought them to police office and asked them to open undershirt, 4). The other cases, a police separated a transgender with his partner. Transgender found difficulty to arrange resident card (its reason: hospitalized patients go to toilet). Many transgender groups are still isolated from the society. They generally, have been not ready yet to inform about their identity to their family. The most problem of stigma by transgender comes from his family because their families do not want to receive this reality. Even, they get discrimination, gossip, ridicule from their family. As a result of these causes this will create social exclusion. They do not want to inform their problem to other non-transvestites. Social exclusion will be associated with poverty and risk factor to their health.
3.3 Social support
Social support can be described as the perceived caring, esteem, and assistance people receive from others (Haber, 1999, p. 212). Support can come from family, friends, spouses, neighbors, health care professionals and so on. Social support (Eng and Young, 1992 cited in Haber, 1999, p. 212) can be divided into three categories: emotional support, instrumental support and informational support. Emotional support refers to a sense of love and belonging. This has a strong relationship to health status (Israel and Schurman, 1990, cited in Haber, 1999, p. 212). When people feel they are being listened to, they develop a healthy sense of self-worth. Furthermore, instrumental support is related to tangible or physical support for instance financial help and household maintenance. Instrumental support has positive correlation with greater life satisfaction. Additionally, informational support refers to provide advice, suggestion, feedback and so on to aid a person solves their matters. Therefore, three social supports as mentioned above are needed by them to reduce probability of illness and speed recovery from illness.
Build social support from friends and others play an important role in helping a person get a greater health. Communities with high levels of social cohesion have, for example, lower rates of coronary heart disease-conversely; these diseases increase when social cohesions decline (the social determinants of health, year, 2006).
In relation to minority group, of course, this is very important for them to get social support from their society particularly from peers and families.
Misuse of alcohol, drugs and tobacco is harmful to health. Alcohol dependence, drug use and smoking are closely associated with social and economics disadvantage and social disruption. Poor economic and social conditions cause more dependence on alcohol and other health and social effects (The social determinants of health, 2006).
In relating to minority groups drug use especially HIV/AIDS caused by Injecting Drug Users (IDUs) also happened on homosexual as minority groups. Data reported in Bali, Indonesia, for example, showed 123 homosexual infected with HIV/AIDS by Injecting Drug Users (IUDs) among 1,986 HIV/AIDS cases (HIV/AIDS in Bali, 2008).
3.5 Government policies
There is not obtained specific data relating to influence of policies affecting health of GLBT groups in Indonesia. Even though it might happen but such problems are not reported. GLBT group’s health problems, generally, are influenced more by the social factors. They are still viewed as sensitive issues in many regions. However, activists of GLBT groups in some countries claim their rights continually for example in China, India, and Philippine (Annual Report, 2007). They struggle to prevent discrimination for GLBT groups.
To protect their rights, many countries have specific laws and/or commissions or ombudsman institutions. For example Indonesia places the rights of GLBT groups in Subcommittee for protection of specific group. Minority groups have eighth sub themes: two of them are GLBT groups and people living with HIV/AIDS (ODHA).
Indonesia also has health insurance for poor people. This program includes GLBT groups if they come from poor people. This program is called “Jamkesmas” However, this policy is not only for LGBT groups as minority groups but this is for all people who are poor. They can get health services in health care centres and public hospital without payment (Health Department of Republic of Indonesia, 2008). They can see doctors and check their health condition regularly. GLBT groups who infected with HIV/AIDS or among IDUs also can get health services without payment. They can obtain health services such as counseling, medicine, blood test, HIV/AIDS test, needle exchange and so on (Health Department of Republic of Indonesia, 2008).
The social determinants that affect the health of ethnic minority groups especially Gay, Lesbian, Bisexual and Transgender (GLBT) are stress, social exclusion, social support and addiction. Furthermore, it is not obtained specific policies that influence the health of GLBT groups. Many health problems that happen for GLBT groups in Indonesia such as Tuberculosis, Hepatitis B, Hepatitis C, but this is not supported by organised data. Therefore, by this paper it is suggested that to increase quality of health services and to solve health problems for all target groups, data are very needed particularly BLGT groups. This target group is very susceptible toward health problems and difficult for them to access health services. It is also suggested to build good collaboration between government and Non Government Organisations (NGOs) to solve health problems faced by GLBT groups.
5. Reference list
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